The sinuses are air cavities in the skull that are surrounded by bone and lined with mucous membranes. Mucous membranes are the “skin” that covers the inside of the nose and the sinuses. This membrane has glands that produce mucous and has hair cells called cilia that move the mucous and filter the air. The job of the nose is to warm and filter the air that passes through the nose during breathing. The sinuses and the nasal cavity produce 1 liter of mucous daily. This naturally moistens the nose and throat and helps in the initial process of food digestion. When the mucous gets trapped in the sinuses and or the sinuses are not breathing well, sinus pressure and possibly sinus infections will occur. People who have poorly breathing sinuses do so because of variations in normal anatomy that narrow the natural sinus doors, if the doors are narrow then air does not get into the sinus as well as it should and mucous cannot get out of the sinus as well as it should. Those individuals that have structurally narrow sinus doors are more prone to sinus symptoms when exposed to allergens, viruses or simple changes in our barometric pressure as these factors increase nasal swelling and block the doors even further. When mucous gets stuck and the sinuses are blocked, the sinus lining will swell and cause pressure over the affected sinus. Sinus patients can often predict the when we will have precipitation as they have an increase in sinus pressure. The sinuses are located over the forehead, between the eyes, over the cheeks and behind the nose. Sinus symptoms are usually located over the sinus that is inflamed at the time. It is common to have pressure between, under, over and behind the eyes with sinus symptoms as the eyes are surrounded by the sinus cavities. Not everyone with chronic sinusitis has trouble breathing through the nose and not everyone with trouble breathing through the nose has sinus problems. Not everyone with chronic sinus pressure gets recurring sinus infections. Those affected by their sinuses each have their own pattern of symptoms that they will describe with variations of what was discussed above.
The first treatment option for chronic sinusitis is to try to conservatively get the sinuses to breath better. This can often be done by using a simple nasal irrigation (like a netty pot) and often a prescription nasal spray. If conservative management does not help the patients’ symptoms, a CT scan can be done to evaluate the patients’ anatomy to see what is blocking the sinus doors. A CT scan does not make the diagnosis of chronic sinusitis as the diagnosis of is a clinical one based on the patients history and symptoms. After the sinus anatomy is evaluated, options are discussed to better open the sinus doors. In most patients a simple balloon catheter is used to widen a sinus opening so they can function better. (This is called Balloon sinuplasty; a very similar concept as angioplasty). After this procedure, no packing or balloons are left in the nose and some can even have it done under local anesthesia in the ENT’s office.